FOI 24/25-0856
DOCUMENT 1
| From: | Aaron |
|---|---|
| To: | Star; Naomi |
| Cc: | Stephanie |
| Subject: | Cleared: RES 335 Reducing Applied Behaviour Analysis over time [SEC=OFFICIAL] |
| Date: | Monday, 8 January 2024 2:06:52 PM |
| Attachments: | RES 335 Reducing Applied Behaviour Analysis therapy over time.docx |
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Hi Star
Please find attached RES 335 Reducing Applied Behaviour Analysis over time.
This task has been cleared by the Tactical Research and Intelligence team. If there are any issues with the paper or any reason it should not be shared with the branch please get in touch with us as soon as possible.
Thanks and all the best
Aaron 47F - Personal
Research Officer
Operations and Practice Improvement
Technical Advice and Practice Improvement Branch
National Disability Insurance Agency
T 47F - Personal E 47F - Personal privacy
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Reducing Applied Behaviour Analysis over time
The content of this document is OFFICIAL.
Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making. Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters, they are to call the TAPS line for advice. The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters
Research question: Is there substantial evidence that a step-down transition away from Applied Behaviour Analysis (ABA) therapy can provide outcomes and be of benefit?
Date: 3/1/24
Requestor: Star
Endorsed by: Naomi
Researcher: Stephanie, Aaron
Cleared by: Stephanie
Literature Review
Summary
This paper considers the evidence for a step-down model of reducing frequency or intensity of applied behaviour analysis (ABA). No evidence was found regarding the effectiveness of a step-down model. One international ABA accreditation body, the Behavioral Health Center of Excellence, recommends a gradual reduction in hours when concluding ABA therapy.
Five papers were attached with the research request. None of the papers directly relate to the efficacy of a step-down model of reducing ABA supports.
Previous TAPIB research has found a lack of consensus regarding appropriate intensity and duration of ABA therapy. Recent Australian guidelines on the delivery of supports for children with autism note that supports should be individualised and there is no set number of hours of therapy which are appropriate for every child.
Previous TAPIB Research Papers
Previous TAPIB research papers related to ABA include:
- RES 246 ABA and positive behaviour support.docx
- RES 292 Applied behaviour analysis for adults with ASD.docx
RES 246 found no evidence for appropriate frequency, intensity or timeframe of ABA required to affect a reduction in behaviours of concern, nor any information on reducing intensity of support over time.
RES 292 found lack of consensus regarding appropriate frequency, intensity or timeframe of ABA. The studies review in this paper emphasised that an individualised approach to determining frequency, intensity and timeframe of supports is required.
Review of Provided Literature
Five papers were attached with the research request (refer to 6. Literature Review table for further details). None of the attached papers were directly relevant to the research question. None of the papers reviewed directly addressed the benefits of an extended timeframe of supports or the benefits of slowly reducing ABA support over time. No quality assessment was completed due to lack of relevance to the research question.
Other Sources
The Behavioral Health Center of Excellence (BHCE) is a private organisation that offers accreditation of applied behaviour analysts. They suggest fading out services gradually based on the needs of the client (BHCE, n.d.). However, BHCE provide no evidence on which they base this recommendation.
Literature Review
OFFICIAL For Internal Use Only
Autism CRC’s recent National Guideline for supporting the learning, participation, and wellbeing of autistic children and their families in Australia (Trembath et al, 2022), makes the following recommendations around duration of supports:
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56.1: The amount and duration of support provision should be tailored to the individual needs of the child and family. This includes consideration of the frequency, length, and time of day of support sessions, and variations in support needs over time.
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56.3: Practitioners should inform parents that there is no set number of hours per week of practitioner delivered child-directed supports that leads to the best outcomes for all children.
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56.4: Practitioners should be aware that research evidence does not support the concept that supports delivered in greater amounts consistently lead to better child and family outcomes (Trembath et al, 2022, pp.95-96).
The National Guideline does not discuss reducing therapy over time.
— Reducing ABA — Page 3 of 7 OFFICIAL Page 4 of 20
Literature Review
OFFICIAL For Internal Use Only
Literature review table
The following papers were attached with the research request.
| Author / Date | Title | Study aim/objective | Relevance to Current Research Question | Quality of included evidence (high/medium/low/very low) |
|---|---|---|---|---|
| 1 Camargo et al 2014 | A review of the quality of behaviourally-based intervention research to improve social interaction skills of children with ASD in inclusive settings | Whether ABA improves social interactions for children with ASD; whether ABA can be considered evidence based. | Not relevant. Paper discusses behavioural components of some interventions for children with autism but does not discuss frequency/intensity of ABA or reducing therapy over time. | N/A |
| 2 Steinbrenner et al 2020 | Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder | Purpose of report is to “describe a set of practices that have clear evidence of positive effects with autistic children and youth” | Not relevant. Report discusses efficacy of multiple ABA programs but does not discuss frequency/intensity or timeframe of supports. | N/A |
| 3 Kadar et al 2012 | Evidence-based practice in occupational therapy services for children with autism | “identify how occupational therapy practice may have changed over the last decade and to explore what additional | Not relevant. Paper briefly mentions ‘behavioural approaches’ but does not discuss ABA, | N/A |
Literature Review
OFFICIAL For Internal Use Only
| Author / Date | Title | Study aim/objective | Relevance to Current Research Question | Quality of included evidence (high/medium/low/very low) |
|---|---|---|---|---|
| spectrum disorders in Victoria, Australia | developments are required in the field” to support children with ASD | reducing therapy over time or frequency/intensity of supports for children with autism. |
4 National Autism Center 2015 Findings and Conclusions: National Standards Project, Phase 2. “provide up-to-date information on the effectiveness of a broad range of interventions for ASD” | Partially relevant. Paper discusses efficacy of behavioural approaches including interventions classed as ABA. Intensity and timeframe of therapy is discussed for Comprehensive Behavioral Treatment for Young Children (CBTYC), often described as ABA. CBTYC is described as an effective evidence-based practice but does not discuss whether the intensity or timeframe of the intervention is | N/A |
Reducing ABA Page 5 of 7
Literature Review
| Author / Date | Title | Study aim/objective | Relevance to Current Research Question | Quality of included evidence (high/medium/low/very low) |
|---|---|---|---|---|
| 5 | Ivy & Schreck 2016 | The Efficacy of ABA for Individuals with Autism Across the Lifespan | Editorial/narrative review regarding the efficacy of ABA across the lifespan for individuals with ASD. | Not relevant. Paper discusses efficacy of ABA but does not discuss frequency/intensity of therapy or reducing therapy over time. |
References
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Behavioral Health Center of Excellence. (n.d.). Suggestions for Ethically Fading Out ABA Services. https://www.bhcoe.org/2016/11/suggestions-ethically-fading-aba-services/
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Camargo, S. P., Rispoli, M., Ganz, J., Hong, E. R., Davis, H., & Mason, R. (2014). A review of the quality of behaviorally-based intervention research to improve social interaction skills of children with ASD in inclusive settings.* Journal of autism and developmental disorders*, 44(9), 2096–2116. https://doi.org/10.1007/s10803-014-2060-7
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Ivy, J.W. & Schreck, K.A. (2016). The Efficacy of ABA for Individuals with Autism Across the Lifespan.* Current Developmental Disorder Reports*, 3, 57–66. https://doi.org/10.1007/s40474-016-0070-1
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Kadar, M., McDonald, R., & Lentin, P. (2012). Evidence-based practice in occupational therapy services for children with autism spectrum disorders in Victoria, Australia.* Australian occupational therapy journal*, 59(4), 284–293. https://doi.org/10.1111/j.1440-1630.2012.01015.x
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National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. https://www.nationalautismcenter.org/national-standards-project/phase-2/
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Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.
The contents of this document are OFFICIAL.
Morning Aaron, I will need to brief you on this AAT research request Monday morning Stepping Down ABA Therapy.
Monday, 8 January 2024
Morning Stephanie, just gonna make a cup of tea but happy to talk about the research request whenever you’re free.
08/01/2024 2:11 pm
Hi Stephanie, if you have a minute, do you mind taking a look at RES 335 Reducing Applied Behaviour Analysis therapy over time.doc? I didn’t find anything directly relevant, but expanded on a bit that was marginally relevant.
Other sources
The Behavioral Health Center of Excellence (BHCE) is a private organisation that offers accreditation of applied behaviour analysts. They suggest fading out services gradually based on the needs of the client (BHCE, n.d.). However, BHCE provide no evidence on which they base this recommendation.
Tuesday, 9 January 2024
initially I thought no, but perhaps it reinforces the lack of research about stepping down ABA so perhaps it is worthwhile 😊
Great, I’ll upload it when I get into the office. 47F - Personal privacy